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(Radiology. 2000;215:824-830.)
© RSNA, 2000

Neuroradiology

Multiple Sclerosis: Magnetization Transfer MR Imaging of White Matter before Lesion Appearance on T2-weighted Images1

G. Bruce Pike, PhD, Nicola De Stefano, MD, Sridar Narayanan, MSc, Keith J. Worsley, PhD, Daniel Pelletier, MD, Gordon S. Francis, MD, Jack P. Antel, MD and Douglas L. Arnold, MD

1 From the McConnell Brain Imaging Center, Room WB-315, Montreal Neurological Institute, 3801 University St, Montreal, Québec, Canada H3A 2B4 (G.B.P., S.N., K.J.W., D.P., G.S.F., J.P.A., D.L.A.), and the Department of Neurology, University of Siena, Italy (N.D.S.). Received December 8, 1998; revision requested February 9, 1999; final revision received September 29; accepted October 6. Supported in part by the Medical Research Council of Canada and Fonds de la Recherche en Santé du Québec. G.B.P., G.S.F., and D.L.A. are Killam Scholars. Address correspondence to G.B.P. (e-mail: bruce@bic.mni.mcgill.ca).

PURPOSE: To determine the evolution of magnetization transfer (MT) in white matter regions before and after plaque development in patients with multiple sclerosis (MS).

MATERIALS AND METHODS: In a 5-year longitudinal evaluation, 30 patients with MS underwent conventional magnetic resonance (MR) imaging, MT MR imaging, and clinical assessment. Cross-sectional data in 12 healthy subjects were also collected. Semiautomated lesion classification with use of T2-weighted MR images was used to measure the time course of the MT ratio (calculated with MR data acquired without and with MT saturation) in every voxel and to help analyze the relationship with the status of lesions depicted on T2-weighted images.

RESULTS: There was a significant (P < .001) temporal decline in lesion MT ratio after lesion appearance on T2-weighted images. A significant (P < .001) progressive decline in MT ratio was also present in voxels that later became lesions, prior to initial detection on T2-weighted images. Even 11/2 years prior to lesion appearance, the MT ratio (33.3%) in regions destined to become such lesions was significantly (P < .001) lower than that in both white matter in healthy subjects (41.3%) and other normal-appearing white matter in patients with MS (38.1%).

CONCLUSION: The MT ratio reveals progressive focal abnormalities in MS that antedate by up to 2 years the appearance of lesions on T2-weighted MR images.

Index terms: Brain, white matter • Magnetic resonance (MR), magnetization transfer, 13.121417 • Magnetic resonance (MR), tissue characterization, 13.121417 • Sclerosis, multiple, 13.871




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